Individual
JULIE M HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3101 BRECKENRIDGE LN, STE 2D, LOUISVILLE, KY 40220-2742
(502) 459-8012
(502) 459-8021
Mailing address
3101 BRECKENRIDGE LN, STE 2D, LOUISVILLE, KY 40220-2742
(502) 459-8012
(502) 459-8021
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7959
KY
174400000X
Specialist
7959
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50002288
PASSPORT
KY
01
—
60002508
MEDICAID - DENTAL
KY
05
—
64073760
—
KY
Enumeration date
08/09/2005
Last updated
01/09/2008
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